Sitting at Ashley’s dining room table, evidence of her creative life surrounds us. On the table, pink and purple doilies remain from a recent Valentine’s brunch with friends. On the walls, Ashley’s photography hangs. As she edits a recent session and laughs with me, it is nearly impossible to picture that Ashley has a medical condition impacting her days.

Ashley is 30 now, and living with her husband, Jim, and their three dogs. Though she has lived in southern New Mexico, California, and Maryland, she now calls Albuquerque home. While New Mexico is regularly commended for its low health care costs, the state lacks a good medical infrastructure and accessing care can prove difficult with the state’s shortage of qualified medical practitioners.

Ashley was only 19 when she learned that she had dangerously high cholesterol levels. Though, she actually remembered having high cholesterol levels even earlier. She recalled, “actually there was some weird test when I was a little kid... it must have been a prick test. But, I was a little kid and then I remember that my uncle checked our cholesterol and he said ‘hers is really high’ but I was just a child. That memory just came back to me.”

While we think of high cholesterol, medically called hypercholesterolemia, as a disease of age, the National Institute of Health recommends that young adults be screened beginning at age 20. And in 2011, the National Heart, Lung, and Blood Institute, a part of the National Institutes of Health, changed that guideline to recommend that children are also screened at least once for high cholesterol between ages 9 and 11, and again between 17 and 21.

It was during a routine blood screening, as part of her yearly physical, that Ashley’s problem was detected. Her levels weren’t slightly elevated, they were shockingly high and at 19, Ashley was told that she was at a high risk for having a stroke.

“There’s no way that you can feel your cholesterol levels rising,” she explained.

The first line of treatment for high cholesterol includes lifestyle changes and Ashley’s doctor recommended that she immediately alter both her diet and physical activity level. At the time, though, Ashley still lived at home and struggled with the idea of meeting her new dietary guidelines while not preparing her own meals. And with the silent nature of her condition - high cholesterol does not cause any symptoms of its own - it was easy for Ashley to brush aside her doctor’s concerns.

For the next several years, life continued as normal as Ashley pursued art in college and received her Associates in Art from New Mexico State University. She explained, “I kind of just neglected going to the doctor… EVER.” Shortly after finishing her degree, she moved to Maryland and it was there that the seriousness of her high cholesterol first became apparent.

Often times, without routine screening, the first sign of high cholesterol is a heart attack or a stroke. Luckily for Ashley, standard blood work prevented that and her first real scare came by way of the documentary, Forks Over Knives. The documentary examines diet and disease, and the idea that many of our most troublesome health concerns - like diabetes, cancer, and stroke - could be prevented or reversed with a whole-food, plant-based diet.

Ashley saw the film the year that it was released, 2011, but even six years later, you can see the disgust and fear that she felt as she recalls watching it. Ashley immediately quit all animal products aside from fish - she gave up meat and dairy, cold turkey. Ashley laughs at the experience now, explaining “I didn’t even know there were vegan alternatives..” At the time, Ashley didn’t swap out ground beef for a veggie burger, or add tofu to her diet. Instead, she just stopped eating everything she knew could affect her cholesterol.

As you can imagine, that type of a diet change is rarely sustainable and eventually, Ashley slipped back to eating a normal Western diet. In retrospect, she notes that it would have been helpful to have her cholesterol rechecked at that time, to see the true effects of her diet changes.

It wasn’t until 2016, at 29, with prodding from friends, that Ashley went back to the doctor for a routine physical. Her friend, Natalie, had told Ashley that “you owe it to yourself to take care of yourself” and Ashley realized that she was right. When she mentioned the high cholesterol result from nearly a decade earlier, and that she likely still had high cholesterol the doctor brushed it aside. Ashley recalls, “she said we’’ll see. Sure enough, she called me the next day.”

Without long term diet and lifestyle changes, the results were exactly what Ashley expected - her cholesterol levels remained dangerously high. Ashley nearly laughs as she recounts her doctor telling her to start Lipitor, a statin medication that lowers cholesterol levels, that very night. I asked Ashley what’s it like being on a serious daily medication, and she admitted that sometimes she forgets to take it but that it’s mostly okay. She explained, “sometimes you have like leg pains from Lipitor. You can’t have grapefruit juice, or grapefruits.”

Ashley’s life at 30 looks very different than it did at 19. No longer is she balancing quick meals between college classes, but life is even busier now.

During the day, Ashley works for a local brewery where she takes photographs, updates taproom chalkboards, and plants succulents as the office's assistant. But, Ashley also co-owns a successful wedding photography business which fills her weekends for nearly nine months of the year. And squeezed in between those two nearly full-time jobs, Ashley provides custom hand-lettering services. Ashley’s passions keep her away from home much of the time, and her days are full.

Even with prescription medication, lifestyle changes for high cholesterol are important. And so, Ashley has returned to a plant-based lifestyle.

Scrolling through Ashley’s carefully curated Instagram feed, you will find lots of hand lettering and photos of her dogs, but also photo evidence of her new lifestyle - potato and spinach tacos, sweet corn and green chile baked flautas, arroz con leche with coconut milk. While cutting out animal products might be the most important dietary change for Ashley, she also avoids grains and sugars when possible - a hard task as a fan of beer, and as an employee of one of the state’s best breweries.

When I asked how she balances it, she explained, “working at a brewery.. I’ll have a beer, and then another beer.. and then I’m hungry, and I’m out. You have to plan everything.” She also admitted that she hates to cook, “I’m never cooking, it’s always Jim. I hate cooking, so that’s the predicament.” But Jim enjoys cooking, and also does the shopping for their new lifestyle. I asked Ashley if the change had forced them to try any new foods but she laughed and told me instead, “I used to like bell peppers and now I hate bell peppers. And so, a bunch of recipes call for bell peppers and... nah. So, that sucks too.” She also explained some benefits though, “during the summer, we like to go and get local delicious produce. We literally had the best honeydew melon of our lives at the Growers Market.”

Community through illness can be valuable and I asked Ashley what that looks like for her. She admitted that she doesn’t know anyone else with high cholesterol her age. She joked, “I’m just a lone, high-cholesterol, person.”

I asked if the seriousness of her condition makes her anxious at times, especially without knowing others with the condition and she explained that it does, and on those days, she’s even more dedicated to sticking to her diet. And while she may not have a formal support group for others eating a plant based diet, she has found consolation in both beautiful and funny cookbooks like blogger Andrea Duclos’ “The Plantiful Table”, or the Thug Kitchen official cookbook.

Ashley hasn’t had her cholesterol checked since starting her nearly vegan diet, and admits that she should have had it rechecked this past December. But, there’s still a big component of her doctor’s recommendations that is missing - exercise. “She said that I need to be exercising... which I don’t do, I have a pretty sedentary life. So that’s something I need to work on. I mean, basically, I have heart disease if you think about it.” But Ashley explained that with her busy schedule, her time at home is mostly dedicated to resting - another important lifestyle modification for any chronic health condition.

Having a silent disease can make it hard to stick with these large lifestyle modifications - after all, there is no immediate punishment for eating the wrong foods - but Ashley is dedicated to maintaining her future health... only, with a beer or two along the way.

Ashley Rose Hamilton is a wedding and portrait photographer, and hand letterer living in Albuquerque, NM. Originally from Southern California, Ashley moved to New Mexico when she was nineteen. Soon after, she was presented with the opportunity to travel the country as a music photographer with Vans Warped Tour. That was just the start of Ashley's photography career, though, and she is now the co-owner of Lola + Rose Wedding Photographers, and the boss babe behind Ashley Rose Halmiton Photography.